Clinical Outcomes of a Furosemide Infusion Protocol in Edematous Patients in the Intensive Care Unit

George Thomsen, MD, Louise Bezdjian, ACNP, Larissa Rodriguez, AS and Ramona O. Hopkins, RN, PhD

Crit Care Nurse December 2012 vol. 32 no. 6 25-34

Corresponding author: Ramona O. Hopkins, PhD, Critical Care Medicine, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, Utah 84107 (e-mail: ramona.hopkins@imail.org).

Abstract

Background: Many critically ill patients have severe volume overload due to vigorous fluid resuscitation. Optimal fluid management strategies to clear tissue edema are unclear.

Objective: To assess safety and effectiveness of a clinical application of a furosemide infusion protocol in edematous critically ill patients.

Methods: A prospective, cohort study of consecutive adult critically ill patients who received furosemide infusion by protocol from June 2003 to July 2004.

Results: The mean total dose of furosemide was 2240 mg. The mean cumulative fluid balance therapy was −3376 mL. Electrolyte values in the critical laboratory range were 3.3% for potassium, 0.2% for sodium, and no critical values for magnesium. The mean change in creatinine level was +0.2 mg/dL during furosemide infusion therapy, but the mean creatinine level returned to baseline by 3 days after the furosemide infusion. A minimum mean arterial pressure less than 55 mm Hg occurred 12% of the time during the furosemide infusion.

Conclusions: Furosemide infusion therapy was associated with moderately negative cumulative fluid balances, electrolyte shifts, and mild transient worsening of renal function.